Director, Medicare

Director, Medicare
Wheeling, WV
Full-Time
Operations - Medicare
VP Medicare

Responsible for the management and administration of the Medicare products administered by THP.  The Director will assist with staff education, communication, problems and procedures and will work closely with the Vice President of Medicare to assure all contractual changes and updates impacting Operations are implemented.  The Director will manage daily operations of multiple levels of staff and multiple functions including but not limited to:

  • Accountable for all aspects of the day to day management of operations functions including but not limited to claims inventory, call center management and enrollment within the Medicare Operations team.
  • Management of processes and procedures to assure quality and compliance standards are met or exceeded. 
  • Owns process and outcomes of issues and in collaboration with internal business partners is accountable to drive research into determining root cause analysis of issues and to proactively address and communicate with management. 
  • Provides leadership both internally and externally (clients, boards, prospects) to our organization.
  • Project management and implementation of various projects as identified but not limited to i.e. NCQA, Stars, and audits.
  • Works cooperatively with internal THP departments, including Finance, Customer Service, Operations, IT, Medical Management, Internal Audit, QI and Compliance to resolve issues and improve internal processes. Provides authority needed to carry out designated task and empowered to make and resolve operational, financial, and policy decisions regarding the Medicare contract.

  • Bachelor’s Degree or equivalent experience;
  • Experience in healthcare insurance operations, public policy development or government relations;
  • Leadership/Management experience;
  • Experience with Medicare or other related government product;
  • Strong analytical skills, including strong listening skills;
  • Clear, concise verbal/written communication skills;
  • Experience leading, formulating and delivering strategy, building strong connections with people and teams.

  • Shows integrity, ethical and conscientious;
  • Accountable with ability to deliver on commitments and take ownership for solving problems and creating solutions;
  • Strong, positive leadership skills;
  • Desire for continuous improvement and innovation with the ability to embrace change and drive new ideas into business solutions;
  • The strong desire to achieve high performance in aspects of the job.

Employment Documents

EEO

Or, if you are interested in a fast-paced career with us, please send resume with salary requirements to:

HR Department 
1110 Main Street
Wheeling, WV 26003-2704
hr@healthplan.org